Collecting from Payers and Patients Is Draining

Last month I said goodbye to a great-aunt who scared me as much as I knew she loved me. In her youth, Aunt Chickie was a badass bookie who would have washed my mouth out with soap if she heard me call her a badass. I remember when "The Sopranos" first aired on HBO and the shock in the media over the "bad language" and constant use of the "f-word" in the show. I didn't get what people were surprised about – that language was a normal Sunday afternoon with my Italian relatives.

I often credit my self-confidence and assertiveness to my Italian female elders who taught me to value myself enough to overcome any trepidation or fear of confrontation that I might feel. That said, I am aware that I can get loud, even shrill, when backed in a corner. And nothing gets my blood pressure higher than when payers and patients dare to delay payment or question the value of services delivered by my husband, the solo pediatrician I collect for.

There is a great line in the film "As Good as It Gets" when Cuba Gooding Jr.'s character gets aggressive with Jack Nicholson and then regrets it blurting out, "I hate doing this! I'm an art dealer." That's exactly how I feel when I hang up the phone with certain patients and insurance representatives (I'm looking at you Aetna). I'm a medical administrator, not a strongman, but sometimes I feel like if I don't lay down the law, I'm never going to get paid.

I am aware that adding to my current stress is the liberal guilt I feel as I watch working and middle-class patients struggle to meet high deductibles. When we first opened our practice nearly 11 years ago, the state of Massachusetts had a generous Medicaid program. Back then I was confident that if a family wasn't paying, and if they didn't qualify for Medicaid, they were cheap, not poor. Today I'm not so sure, as even in liberal Massachusetts qualifying for and staying on Medicaid is much harder. Not only that, but like many of our fellow practices, we've had to cut back on the number of Medicaid patients we can see due to extreme reimbursement cuts.

Our financial policy, which we strictly adhere to, states that patients pay all bills in full and on time or they are dismissed from the practice. Primary-care is a marathon, not a sprint, and we are fortunate to work in a community where the patients outnumber the providers. But, even though I can afford to banish non-payers, it still weighs heavy on me.

At the end of the day, I must collect every penny owed to our practice in order to remain a viable business. One of my favorite episodes of "Friends" is when Phoebe and Monica cater a funeral and the widow turns on the waterworks every time Monica tries to collect on the bill. Pheobe lectures Monica stating, "Look, I've had a lot of jobs, okay, and there are some people who just always try to get out of paying. It's either, you know, 'That massage wasn’t long enough,' or, 'I don't recognize any of those songs,' or, you know, 'These sombreros aren't big enough. Bad little white girl!'"

Pediatricians need to be paid and I'm not going to apologize for earning a living.

How are your payer relations and patient collections? Are you a pushover or, worse, an aggressive bully? How do you deal with the stress of collecting from patients?